Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2016; 22(46): 10219-10225
Published online Dec 14, 2016. doi: 10.3748/wjg.v22.i46.10219
Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study
Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Fernanda Branco, Angelo Alves de Mattos
Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil
Fernanda Branco, Ultrasound Imaging Service, Hospital Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
Author contributions: All authors contributed to this paper with conception, drafting, revision, and approval of the final version of the manuscript.
Institutional review board statement: The study protocol was approved by the institutional review board for human studies at the Universidade Federal de Ciências da Saúde de Porto Alegre and complied with the guidelines of the Brazilian Ministry of Health.
Conflict-of-interest statement: The authors state no conflicts of interest. No financial support was provided for the study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Marcelo Campos Appel-da-Silva, MD, MSc, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Dona Laura, 87/202, Porto Alegre, RS 900150-170, Brazil. marceloappel@yahoo.com.br
Telephone: +55-51-32225366 Fax: +55-51-32225366
Received: August 26, 2016
Peer-review started: August 29, 2016
First decision: September 20, 2016
Revised: October 4, 2016
Accepted: November 14, 2016
Article in press: November 16, 2016
Published online: December 14, 2016
Processing time: 108 Days and 15.6 Hours
Abstract
AIM

To determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.

METHODS

In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.

RESULTS

Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54 (0.15-1.89), P = 0.33].

CONCLUSION

HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.

Keywords: Liver cirrhosis; Hepatocellular carcinoma; Epidemiology; Surveillance; Survival

Core tip: This retrospective cohort chart review study provides novel data regarding the incidence of hepatocellular carcinoma (HCC) in the South of Brazil. Of 453 patients with cirrhosis attending a specialized reference clinic between March 2005 and March 2014, 75 (16.6%) developed HCC, with a cumulative incidence of 2.6%, 15.4% and 28.8% in the 1st, 5th, and 10th year respectively. Early-stage HCC was more often detected in patients undergoing strict surveillance every 6 mo. Results from this study highlight the need for strict surveillance programs favoring early diagnosis and, probably, a better prognosis.